Let Me Eat All the Foods I Love

Let me Eat All the Foods I Love

including Grapefruit, Chocolate, Cheese, Pomegranate, Black Tea, Spinach and Licorice

by Mary Bamford, Registered Dietitian

I love all these foods, so why would I ever recommend that they not be eaten?  The answer is that these foods interact with some medications.

When you take some medications, combining them with great foods such as these can be fatal.  Food and drug interactions can be very serious.

I am heartened that with nutrition consulting, I help people delay or reverse the need for many medications that interact adversely with foods....and therefore enjoy all the foods they love.

While there will always be people who get ill despite clean living, more than half of major modern illnesses can be prevented or delayed with real changes to nutrition, exercise and lifestyle habits.  This includes cancers, heart disease, diabetes, osteoporosis, obesity and many more. 

Below are some examples of some food and drug interactions.  The number of possible interactions between food and drugs is infinite, so there will always be more findings to add to this list as more research is done.

FOOD	DRUGS	COMMENTS
Grapefruit  (contains the natural compound bergamottin) (Recent adverse reaction reports and animal studies identify that pomegranate and cranberry may have similar effects)	Lipid-lowering statins (Lipitor, Zocor, Mecavor, Advicor)---but not Pravachol (pravastatin) Anti-anxiety drug Buspar (buspirone) Insomnia drug Halcion (triazolam) Anti-malaria drugs Quinerva or Quinite (quinone) Additional possible interactions calcium channel blockers antidepressants sedatives immunosuppressives drugs for erectile dysfunction	Increases drug effect, can be toxic. For vulnerable people, less than 1 cup a day for 3 days taken prior to their medication increased drug levels an average of four times. Interferes with Cytochrome P450 Enzyme System in Liver which processes about 50% of drugs currently prescribed. It can take up to 4 days for the effects of grapefruit to wear off.
Dark Green Leafy Vegetables E.g. parsley, kale, collard greens, spinach, mustard greens, chard, beet greens, dandelion greens And double portions of Brussels sprouts, broccoli, rapini	Coumadin (warfarin) a blood thinner	Be consistent in the amount you consume every day.  A sudden increase in intake can cancel out the drugs effect and be life-threatening These vegetables are extremely nutrient dense, so it is much better to eat a consistent amount each day than to avoid them. Have 1 serving of dark green vegetable every day and get your blood levels monitored regularly One serving is  1 cup of raw, tender leafy salad greens (parsley, spinach, chard),  OR 1/2 cup cooked leafy greens (kale, collards) OR 1 cup of Brussels sprouts broccoli or rapini
Highest calcium foods including milk, yogurt,, calcium fortified juices, calcium set tofu	Antibiotics (Cipro and tetracycline)	Decreases the effect of the antibiotic when consumed with highest calcium foods
Chocolate, Beer, Wine Avocado, aged cheese  and other tyramine-rich foods	Antidepressants that are MAO Inhibitors	Increase drug effect and can dangerously increase blood pressure
Beer	Anti-cancer drug tamoxafen	Increases drug effect
Black Tea Some Herbal Teas (St. John’s Wart, goldenseal, feverfew, cat’s claw)	Potentially all drugs metabolized in P450 liver enzyme system...which is about 50% of all drugs (see Grapefruit for examples)	Increases the effects of drugs by Interfering with P450 system in liver that metabolizes drugs & NHPs. As a general rule, do not take your medications with these teas. Consume black tea in moderation.  Choose green and white teas more often.
Red wine and peanuts (containing resveratrol)	Coumadin (warfarin) a blood thinner (and potentially all the same medications as grapefruit, but more research is needed)	Supplemental amounts of resveratrol are more likely to cause problems than the amounts in food with a moderate intake  Up to 2 glasses of wine and 2Tbsp of peanut butter per day are not expected to interact.
Black Pepper	Allergy Medication (Allegra--fexofenadine)	May increase drug effect
Natural licorice	Beta Blocker class of heart medications	May decrease drug effect

If you take prescription medications, over-the-counter medications or natural health products (NHPs) it is important to know how the food you eat interacts with them. Ask your medical doctor, naturopathic doctor, pharmacist or Registered Dietitian.  Even better, talk to all four.

If you want personalized consulting to ensure you are making the best food choices for you food preferences, health needs and lifestyle, I can help.  Consider booking an appointment.  Learn more at my website www.essencenutrition.ca.

Is bread the new cake?

Is bread a delicious demon?  Is it so lovely and convenient that it tempts us to eat too much?  My mouth waters just thinking about all they ways to include bread at every meal and snack.

Bread is a daily habit for many.  It is an easy choice.   And when we eat 100% whole grain including the germ, we feel good about our choice.....and it is a good choice.  But....

What is the threshold for having too much bread?  At what point is it a treat like cake?

First for "white" or refined grains

If you care about your waist size, then you want to avoid or strictly limit your intake of white or refined grains....in other words think of white bread as you would cake.

Refined grains mean the most nutrient dense parts of the grain is removed--the germ and the bran.  All that is left is the starchy calories.  Our body handles these starchy calories the exact same way it handles table sugar.  A single slice of  white bread looks like 4 to 5 teaspoons of sugar to our insides....so yes that is a lot like cake.

Health Canada (through Canada's Food Guide) is okay with people consuming half their grain choices (3 to 4 per day) as refined grains.   I personally found this to be a very disappointing interpretation of the evidence for optimal health.  The problem Health Canada faced was that it needed more research to justify asking the population to reduce its refined grains.  More than 80% of the grains consumed by Canadians are white or refined and the proof that this contributes to poor health was not there.

But that evidence is finally emerging. Horray!  A recent large and long-term study published in The American Journal of Clinical Nutrition compared visceral belly fat and waist circumference of whole grain eaters vs. refined grain eaters.  It is well established that a larger waist circumference and more visceral fat (the fat beneath your abdominal muscles, that mingles with your vital organs) is a significant risk factor for heart disease, diabetes, cancer and premature death.

People who eat 4 servings of refined grains per day had much larger waists and more visceral fat than people who did not---even if they also ate whole grains.  People who ate at least 3 servings of 100% whole grains per day avoided refined grains had 10% less visceral fat than those who regularly consumed white grains.

In the study, people got most of their white grains from pasta, white bread, pizza, english muffins and white rice.  Note that a popular 12" sub bun is 6 servings of white bread. Two cups of cooked pasta is 4 servings.

If I am at a restaurant that only offers refined white grains, I skip the grain and have a piece of fruit or a baked potato to fill up.  Most of the time, I would rather eat cake or chocolate for my treat than white grains.

Second....Can we eat too much 100% whole grain?

We absolutely need 3-4 servings of a variety of whole grains each day to meet our nutrient needs.  That is about a half to 3/4 of a cup per meal of cooked grains like oatmeal, brown rice, quinoa, pot barley, wheat berries, stone ground cornmeal, popcorn and whole grain pasta.  Choosing 100% whole grain bread for some but not all of your grain choices is healthy.

In the ideal scenario, after that first 2 cups of whole grain, we know that filling up on more vegetables and fruit is super-healthy.  There is no need to add more grains until you have had at least 4 to 5 cups of vegetables and fruits first.  If you are still hungry, more grains and vegetables and fruit make sense.

However the research behind the benefits replacing some of our grain choices with fruits and vegetables is in its infancy, so it is not a general population-wide recommendation.

One promising area of research is related to the acid-base balance of diets.  Grains create a more acidic environment in the body while vegetables and fruits are broken down into more alkaline or basic components--yes even acidic fruits like lemons and oranges metabolize to be alkaline in the body.  When we eat a lot of grains, the body breaks down bone and muscle to neutralize the acid produced.  Over time, weak bones and weak muscles lead to frailty, osteoporosis and fractures.

This is fascinating stuff, but not conclusive.  So the final answer about too much is not available.  In the meantime it does no harm and is definitely beneficial to eat more vegetables and fruit while reducing grain intake.

If you are still uncertain of the best choices for you personally, consult with a Registered Dietitian to get help making choices and changes that are optimal for your unique health and lifestyle needs.  Healthy and delicious eating can be part of busy lifestyle.

So is bread the new cake?
White bread yes.  Whole grain, not so much....but choose to eat not so much.

Eggs--Friend or Foe?

A recent article in the November 2010 issue of the Canadian Journal of Cardiology compared the cholesterol in an egg to the cholesterol in a KFC Double Down Sandwich.  A single egg yolk has 215-275 mg cholesterol compared to 150 mg in the Double Down.  This little factoid has led many to the conclusion that a Double Down is a healthier choice than an egg.  My clients have been asking and I had to investigate this for myself.

Here is an overview of evidence in response to the questions “Does the consumption of eggs or other high cholesterol foods (such as shrimp) more than four times per week result in increased heart disease risk?”

• Current dietary cholesterol recommendations for healthy individuals - consume <300 mg/day. 

• For individuals at high cardiovascular risk (including those with coronary heart disease, diabetes or dyslipidemia), dietary cholesterol recommendations are <200 mg/day. 

• The contribution of eggs to dietary cholesterol intake should be considered in terms of a whole diet approach. 

• Dietary cholesterol is one factor involved in heart health. Other factors to consider are weight, physical activity, smoking, sources of dietary carbohydrate, and type of fats in the diet.

A high fat fast food sandwich like the Double Down is not a healthier alternative to eggs as suggested in the news media, and the authors of the review acknowledge that they are only pointing out that eggs can provide a high intake of dietary cholesterol. 

When used in moderation eggs can be part of a healthy pattern of eating.  They are an excellent source of high quality protein, Vitamin E, Lutein and many other important nutrients that the Double Down just does not provide.

For a tailored plan on heart healthy eating based on your personal preferences and needs, it is recommended to consult a registered dietitian.

So ultimately, eggs are eggs--neither friend nor foe.  Enjoy them appropriately. Four servings of higher cholesterol foods per week do not increase risk of heart disease, even in those who are at higher risk.

And of course work on your total lifestyle--maintain a healthy weight, quit smoking, be active every day, reduce salt intake, choose more omega-3 and monounsaturated fats, choose carbohydrate food such as vegetables, fruits and 100% whole grains most often (i.e. limit intake of sweets and 'white' or refined grains.)

Need inspiration to lose weight? Christie Blatchford's story delivers a refreshing perspective

Christie Blatchford's take on diets in Saturday's Globe and Mail is worth reading if you need a little inspiration.  She shares personal details of her journey to lose 22 pounds with humour and without judgement.  She treated the task of losing weight much like she probably treats a project at work.  That is a helpful approach.

The headline and byline describe quite succinctly a way of thinking that works for her.  "You have a choice: Be fat or be thin. Both have their pitfalls.  If you want to be thin, you have to eat with discipline, exercise and maintain constant vigilance.  But it is better than the alternative."  

Would a similar way of thinking help you?  It is well proven that how you think about your choices and weight loss affects how you feel about them.  And how you feel definitely influences how you act.

Someone who thinks and feels that they should be able to eat 3 candy bars a day and be healthy will make very different choices than someone who thinks and feels that 3 candy bars a week is healthy.

Christie Blatchford closes the article with some wishful thinking around one of her challenges.  She attends a lot of meal functions and picks up coffee when she is hungry.  She reflects that it would be nice if these functions had better choices and portions so that she did not need to use so much discipline and vigilance.

I hope she follows up in a year and reflects on her ongoing story of keeping the weight off.  Based on successes of many of my clients, the job gets easier.  She will not longer work so hard to avoid "those overgrown cakey muffins".  Her thinking and feeling about them will have changed again.

Congratulations Ms. Blatchford and thank you for sharing your story.  I think it will help many people.